This post originally was published here.
Do you experience pain with sex or when inserting a tampon?
Do you or your partner feel like you've hit a wall when trying to enter your vagina, which can make sex feel impossible?
Have you been told to just "relax" or "use more lube" to make sex happen?
Maybe you were told pain with sex is normal because you just had a baby.
If you answered "yes" to any of the above, you're not alone and what you are experiencing is not in your head.
You may have already shared this experience with your doctor or other healthcare providers and are looking for treatment options, or this may be something you haven't felt comfortable talking about and wonder if there's help.
As a pelvic health physiotherapist, I see many women who experience pain with sex for various reasons. Some women have always experienced internal pelvic pain while others don't experience it until later in life, sometimes during pregnancy and many others experience pain after childbirth.
What does your pelvic floor have to do with pain with sex or penetration?
Your pelvic floor muscles attach from you pubic bone to tailbone (front to back) and sitz bone to sitz bone (side to side). If these muscles are tense/tight or have scarring, this can lead to pain during sex or any sort of penetration including inserting a tampon.
Vaginisimus refers to the involuntary contraction or spasm of pelvic floor muscles that occurs with attempted penetration of the vagina.
Provoked vestibulodynia (PVD) refers to pain in the vulva vestibule (the area between and surrounding the labia including the urethra and vagina opening) when touched or with attempted vaginal penetration.
Dysparuenia refers to pain with penetration (may not involve pelvic floor muscle spasm).
Did you know there can be physical and non-physical causes of vaginisimus, PVD and dyspareunia?
Physical causes include frequent urinary tract or yeast infections, tearing/episiotomy or complications with childbirth or a history of pelvic surgery.
You also may have tight pelvic floor muscles due to sitting and standing with poor posture (ie. tucking your bum under) or from constant tightening of these muscles without knowing how to relax them (aka trying to maintain a constant kegel or repeated kegels without letting these muscles release).
Non-physical causes can include fear or anticipation of pain with intercourse or stress from a previous traumatic sexual experience. Fear or anticipation of pain can cause muscles in your body including your pelvic floor to tense and tighten which can lead to pain.
For some women, internal pelvic pain can occur because of a combination of physical and non-physical causes.
How can pelvic health physiotherapy help if you have pain with sex?
Education about your pelvic floor muscles and why your pain might be occurring;
Learn postures, breathing techniques and various relaxation strategies to help release muscle tension and relax your nervous system;
External manual release techniques for muscles that relate to your pelvic floor tension (ie. adductors, glutes, abdominals);
Internal manual release techniques to relax your pelvic floor muscles;
Internal and external release techniques to reduce scar tension (includes vaginal tearing/episiotomy, pelvic surgery or cesearan scar);
Dilators may be recommended to help with vaginal accommodation.
While pelvic health physiotherapists work with the physical side of pain with sex, we also begin to address your fear, anxiety and/or stress that often accompanies vaginisimus/PVD/dyspareunia. You may find you're starting to avoid sex and have difficulties discussing these feelings with your partner which can contribute to the continuation of your pain.
A sex therapist can be a helpful to work with in collaboration with your physiotherapist since they can also help you work through feelings of anxiety/fear/stress which can help to resolve your pain.
I want you to know that you don't need to live with pain during sex. While it may be common, similar to incontinence, it doesn't need to be your 'new normal'. Pelvic health physiotherapy can make a drastic difference in your symptoms and help you achieve your health goals.
If you found these answers helpful please share with others. Feel free to connect with me by email or on Facebook or Instagram to stay up to date on new info about all things pelvic floor and core during bump, birth and beyond stages of life!
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